This therapeutic class has long ranked as the top specialty pharmacy area in terms of pharmacy benefit spend for multiple PBMs. And in 2019, Cosentyx was a preferred alternative for the inflammatory conditions class. In a footnote on the exclusion, Cigna explains that “product placement for treatment of Inflammatory Conditions in the Inflammatory Conditions Care Value (ICCV) Program are subject to change throughout the year based upon changes in market dynamics, new indications for existing products, biosimilar and new product launches.” Indeed, in 2020, Taltz was excluded in the inflammatory conditions class, and Cosentyx was a preferred alternative. Of the preferred therapies, Taltz - a humanized interleukin-17A antagonist indicated for adult and pediatric plaque psoriasis, psoriatic arthritis, ankylosing spondylitis and non-radiographic axial spondyloarthritis - is the only one with the same mechanism of action as Cosentyx. Then they will receive the card in six to eight weeks following the second fill. To qualify for the debit card, patients must fill a prescription for a preferred agent at least once before Aug. Pfizer’s Xeljanz (tofacitinib) and Xeljanz XR.Janssen’s Stelara SC (ustekinumab) and Tremfya (guselkumab) and.AbbVie Inc.’s Humira (adalimumab) and Skyrizi (risankizumab-rzaa),.Amgen’s Enbrel (etanercept) and Otezla (apremilast),.Eli Lilly and Co.’s Taltz (ixekizumab),.The letter specified the following as preferred brand options, as noted in Cigna’s 2021 National Preferred Formulary Exclusions in its “Inflammatory Conditions where COSENTYX is indicated” category: “Those who may have already switched are also eligible.”

“In an effort to encourage these patients to begin using a preferred brand option,…we will be sending them a letter offering a $500 debit card to make the switch,” reads the letter. It noted that because Cosentyx was no longer on its preferred drug list, patients who remained on that agent were paying a higher copay or coinsurance. The debit cards may be used for “health care services and products.”ĪIS Health received a copy of the March 10 Cigna letter to providers. The change will not impact people taking Remicade for polyarticular juvenile idiopathic arthritis. On July 1, the company shifted Remicade to nonpreferred status and moved the two biosimilars to preferred status. Then in June, via its Shared Savings Program, the company said it would offer $500 debit cards to people who switch from Remicade (infliximab), from Janssen Biotech, Inc, a Johnson & Johnson company, to a preferred product or one of two of its biosimilars: Amgen Inc.’s Avsola (infliximab-axxq) and Pfizer Inc.’s Inflectra (infliximab-dyyb). The company also has a nonpreferred formulary tier. Cosentyx is a human interleukin-17A antagonist approved for adult and pediatric plaque psoriasis, psoriatic arthritis, ankylosing spondylitis and non-radiographic axial spondyloarthritis. 1 - to one of its preferred inflammatory treatments. As of early 2021, each of the Big Three - CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth Group’s OptumRx - was excluding more than 400 products.Įarlier this year, Cigna began offering people on Novartis Pharmaceuticals Corp.’s Cosentyx (secukinumab) a $500 debit card if they switched from that agent - which moved from preferred to excluded status on Jan. PBMs began implementing formulary exclusion lists about 10 years ago, and specialty drugs have made up an increasing number of the excluded products. That effort is facing pushback from several medical associations, but if it proves to be successful, other companies could follow suit, suggest industry experts. However, at least one payer has gotten more aggressive with its tactics to get members to move from an excluded drug to one with preferred status, dangling a financial incentive for members. PBMs have used formulary exclusions as an effective way to negotiate with manufacturers for several years.

Inflectra copay assistance